Credit Application

Your Name (required)

How long in business?

Physical Address

Mailing Address

Office Phone

Mobile Phone

Fax Number

Email #1

Email #2

Business Type
CorporationPartnershipProprietorshipOther

List Corporate Officers, Partners, or Owners

Have you ever filed for bankruptcy?
YesNo

If Yes, when?

Sales Tax Exempt?
YesNo

If Yes, please upload & attach a copy of State Exemption Certificate?

Purchases Order No. Required?
YesNo

Type and Amount of Credit Applied for:

Please list 4-5 Vendor references and 1 Bank reference:

Please list: Jobs and Locations, Owners and/or General Contractors, Contacts, Affiliate Companies, etc.

The Undersigned agrees to pay promptly when due all invoices representing purchases on credit pursuant to this application, including applicable late charges, if any. All accounts are payable at Seller’s offices and shall be paid to Seller at mailing address as shown on Seller’s invoice. Default in payment shall entitle Seller to recover it’s collection cost, reasonable attorney’s fees and interest, or at its option, to recover the merchandise without liability of any kind and will give Seller cause to terminate further rentals on an open account basis.

Authorized Digital Signature:

Date of Signature: